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0591• t`..�d;L�, w;�:^„��,�t ;r `'�"•`..�'.�"S:;.nr;'�”"i1i��-'T•�".,�"'".y��.=�i.�r"�i,.•, v;,,;:F�*._�,Ty=..-�:Ye"�.`«..rw'i'�C�; "•�YrJ*^''t.�-'V'",t��---=+.".�c�p�(;��7.'.F•-r-M1:q�('�@y'[{ r•-'-•bk t ..+L,"'s�, l.'sv't'��Y�.� �r 9�h�r'»• _ _ /+OS��i►�A�a'yT!�+C�•�-r .sir•-w'�..-�:.�'-r+..w �. .r-�-i►!G:�-r� -.Y�+w .� rw r. .r-.rt.r.M�,. �w �l�++� r.. r, w�•� ►wr..�..rr�-� r.� �. .w. moi. �r w� NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit— Class III DATE: lle� Minor Improvement Permit Class IV LOCATION/F CONY RUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION DIMENSI,0N OF INSTALLATION OR REMOVAL s., SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) ;;&40.4 ./ 0�,P� 11�7 � �� APPROXIMATE TIME OF'COMPLETION ESTIMATED CONSTRUCTION COST $ QQ05i f0� 3 4-i9-90 14 (Including removal of all obstruction, materials, and debris, backfilling, com- A S'H i IUTAL 1 1000 paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of LaQuinta and to' pay for any additional replacement necessary as the result of this work.. Name of Contractor an /reman Business AddressTelephone No. Contractor's License No. City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. $ Received by Date Recorded by N° 0 591 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSU D - By /f Administrative Authority TELEPHONE: (619 564 2246 r ..+�+ie+�i..�a.-a.r��i..se.iw.. ae Mc �«+.r �+w .► ,+.. �. r w w r — ..+r. — — — — r r — .:: — — w , - — — r w w — w «..«. — — — — NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class III DATE: Minor Improvement Permit Class IV LOCATION/F/CONS$ RUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION PTION OF CONSJRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) In consideration of the granting of this permit, the applicant hereby agrees to: /77, 7�) � i�051 CASN i,` f� 1' 1 ii rd -9A 114 J. 0.06 Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. Name of Applicant (plIgise print) Signature of Applicant or Business nt .� Telephone Name of Contractor an1513reman Business Address Telephone No. Contractor's License No. City Business License No. ell" A/ Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. 0 $ Received by Date Recorded by 0594 PERMIT VALIDATION PERMIT NO. DATE APPROVED���� EXPIRATION DATE�� DATE ISSUED % By Administrative Authority TELEPHONE:61 '564-2 4 ( 9) 2 6